Division of Vascular Surgery, The Surgical Outcomes Research Group, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA.
J Vasc Surg. 2010 Jan;51(1):122-9; discussion 129-30. doi: 10.1016/j.jvs.2009.08.006. Epub 2009 Dec 2.
This study was conducted to evaluate and compare the rates of postoperative infectious complications and death after elective vascular surgery, define vascular procedures with the greatest risk of developing nosocomial infections, and assess the effect of infection on health care resource utilization.
The Nationwide Inpatient Sample (2002-2006) was used to identify major vascular procedures by International Classification of Diseases, 9th Clinical Modification (ICD-9-CM) codes. Infectious complications identified included pneumonia, urinary tract infections (UTI), postoperative sepsis, and surgical site infections (SSI). Case-mix-adjusted rates were calculated using a multivariate logistic regression model for infectious complication or death as an outcome and indirect standardization.
A total of 870,778 elective vascular surgical procedures were estimated and evaluated with an overall postoperative infection rate of 3.70%. Open abdominal aortic surgery had the greatest rate of postoperative infections, followed by open thoracic procedures and aorta-iliac-femoral bypass. Thoracic endovascular aneurysm repair (TEVAR) infectious complication rates were two times greater than after EVAR (P < .0001). Pneumonia was the most common infectious complication after open aortic surgery (6.63%). UTI was the most common after TEVAR (2.86%) and EVAR (1.31%). Infectious complications were greater in octogenarians (P < .0002), women (P < .0001), and blacks (P < .0001 vs whites and Hispanics). Nosocomial infections after elective vascular surgery significantly increased hospital length of stay (13.8 +/- 15.4 vs 3.5 +/- 4.2 days; P < .001) and reported total hospital cost ($37,834 +/- $42,905 vs $11,851 +/- $11,816; P < .001).
Elective vascular surgical procedures vary widely in the estimated risk of postoperative infection. Open aortic surgery and endarterectomy of the head and neck vessels have, respectively, the greatest and the lowest reported incidence for postoperative infectious complications. Women, octogenarians, and blacks have the highest risk of infectious complications after elective vascular surgery. Disparities in the development of infectious complications on a systems level were also found in larger hospitals and teaching hospitals. Hospital infectious complications were found to significantly increase health care resource utilization. Strategies that reduce nosocomial complications and target high-risk procedures may offer significant future cost savings.
本研究旨在评估和比较择期血管手术后感染并发症和死亡的发生率，确定发生医院感染风险最大的血管手术，并评估感染对医疗资源利用的影响。
利用 2002-2006 年全国住院患者样本（Nationwide Inpatient Sample），通过国际疾病分类第 9 版临床修订版（ICD-9-CM）代码识别主要血管手术。确定的感染并发症包括肺炎、尿路感染（UTI）、术后败血症和手术部位感染（SSI）。使用多变量逻辑回归模型计算感染并发症或死亡作为结局的病例混合调整率，并进行间接标准化。
共评估了 870778 例择期血管手术，术后总体感染率为 3.70%。开放式腹主动脉手术的术后感染发生率最高，其次是开放式胸科手术和主动脉-髂股旁路。胸主动脉腔内修复术（TEVAR）的感染并发症发生率是腹主动脉腔内修复术（EVAR）的两倍（P<.0001）。开放式主动脉手术后最常见的感染并发症是肺炎（6.63%）。TEVAR（2.86%）和 EVAR（1.31%）后最常见的是 UTI。80 岁以上老年人（P<.0002）、女性（P<.0001）和黑人（P<.0001 与白人和西班牙裔相比）术后感染发生率更高。择期血管手术后医院感染显著延长了住院时间（13.8±15.4 天比 3.5±4.2 天；P<.001）和报告的总住院费用（37834 美元±42905 美元比 11851 美元±11816 美元；P<.001）。
择期血管手术的术后感染风险差异很大。开放式主动脉手术和头颈部血管内膜切除术的术后感染并发症发生率分别最高和最低。女性、80 岁以上老年人和黑人择期血管手术后发生感染并发症的风险最高。在系统层面上，较大的医院和教学医院也发现了感染并发症的发展存在差异。医院感染并发症显著增加了医疗资源的利用。减少医院感染并发症并针对高风险手术的策略可能会带来显著的未来成本节约。
Zotero 插件